DRG Validation involves in-depth clinical review by our highly experienced and credentialed coding professionals. To identify coding and sequencing errors that impact DRG assignments, we use our proprietary Dynamic Discovery™ technology to analyze paid claim data in search of anomalies. Once revealed, the audit team requests medical records, lets the provider know which claims are in dispute, and begins its thorough examination of the data provided. Our certified specialists know the most effective way to present data to ensure a timely turnaround, provider transparency and successful outcomes.

How It Works:

Pre-Paid claim data is analyzed for anomalies such as mismatched diagnosis and procedure codes

Once identified, medical records for coding audit are requested

Facility is provided with a thorough explanation of coding issues and submits any other relevant documentation to HealthMind